The health-related Millennium Development Goals (MDGs) 2015: Rwanda performance and contributing factors

Introduction The Millennium Development Goals (MDGs) 2015 are the eight international development goals adopted by the Millennium Summit of the United Nations in 2000 to which Rwanda is signatory. In 1990, Rwanda was at least one of the Sub-Saharan Africa countries with poor performance on health-related MDGs indicators. To date, despite the setbacks caused by the 1994 genocide, impressive performance is registered. The objective of the study is to document Rwanda gradual progress to achieving the health-related MDGs 2015 targets from 1990 to 2014/2015. Methods The study is retrospective and comparative documenting the period of 1990 to 2014/15. Results The performance of Rwanda on health-related MDGs 2015 targets is impressive despite the negative effects of the 1990-1994 civil wars and the 1994 genocide against Tutsi on 1990's levels. In effect, out of 17 health-related MDGs indicators, eleven (11) registered “remarkable” performances, i.e. reached global levels or fastened Vision 2020 targets attainment, two (2) registered “good performances”, i.e. reached basic or revised own targets exhibiting overall impressive performance, while four (4) “weaknesses” are observed, i.e. accused gaps until now. The good governance, Vision 2020 effective implementation, consistent resources invested in health sector and the Rwanda Universal Health Coverage implementation contributed greatly to achieving the above health-related MDGs 2015 performance. Conclusion Rwanda performance of health-related MDGS 2015 targets is impressive. However, some relative gaps still persist, and hence should be prioritized while implementing the emerging Sustainable Development Goals.


Results
The results are framed around the (i) Gradual progress from the  Figure   4; (iii) Persisting gaps up to date. If any, the gap is presented in simple deviation (Actual-Target) from the target and not in relative ((Actual-Target)/Target)*100 to avoid any confusion. As advantage, the gap presented using "Actual-Target" will keep the same nature Globally, the poverty line indicator was defined by "the proportion of the population living on less than $1 a day" [1] and presently less than $1.25 a day [4]. According to the first Integrated Household  Height-for-age (stunted): The 1992's level was 48% [13], 43% in 2000, rose to 51% in 2000, declined to 44% in in 2010/2011, and thirty-eight percent (38%) of children were stunted [14], according to RDHSV 2014/2015; the basic target is not achieved and the gap is 14% of reduction compared to basic target set at 24% and revised at 24.5% [8].

Indicator 17: proportion of births attended by skilled health personnel
The indicator decreased from 25% in 1990 (RDHSI) [13] to 19% in 1996 [2], gradually increased to 35%, 39 [16] and two years later at 3% [17]. Since then to present, the HIV prevalence remains the same (3%) [14]. It should be naïve to confirm that the basic target set at 5% by 2020 [5] was attained within 3 years of MDGs implementation; the explanation could be that the later target (5%) was set using data issued by surveys conducted in sentinel sites with a high exposure risk.  [2]. In 2012, malaria cases were only 5.2% and the mortality rate was 5% corresponding to 90% of relative reduction for morbidity and mortality [18]. This score reveals the fastened achievement of revised target set at 5% for Vision 2020 reflecting an impressive progress in halting and reversing the epidemic. Unfortunately, the disease is resurfacing since 2013/2014.

Indicator 23: incidence associated with tuberculosis
According to data on Tuberculosis (TB) for Rwanda in 2012/2013 [7], the indicator declined from 98/100,000 in 2000 to 69/100,000 in 2013; therefore, the incidence is halted and reversed.

Contributing factors:
The literature review shows that amongst numerous contributing factors of the above achievements, the good governance, especially good governance in health is unanimously ranked first. This is in accordance with the study on the good governance and health [19]. The literature review shows also that Vision 2020 [5] is one of potential contributing factors. The  [14] surpassing the basic target set at 14.5% ,and thus the remarkable performance is noted. In sub-Saharan Africa, the underweight rate has fallen from 29% in 1990 to 20% in 2015, i.e. only 31.03% instead of 50% required. Worldwide, the rate decreased from 25% in 1990 to 14% in 2015, i.e. 44% still less than 50% required [4]. the related exact data is not retrieved for the two WHO regions.
Indicator 13: under-five mortality rate per 1000 live births: The Rwandan indicator estimated at 50/1,000 in 2014/2015 [14] is between the regional worth 90.1/1000 and the global worth 45.6 deaths/1000 [22]. Having achieved exactly the basic target set at 2015, it is to be considered as good performance.  [14] versus its own basic target set at 75% and thus considered as remarkable performance. In effect, the Rwandan indicator surpasses the WHO African Region's worth 51% between 2007 and 2013 [22] and the global one worth 74% in 2014 [4].
HIV prevalence amongst men and women aged 15-49 years: With regards to HIV prevalence, the indicator declined from 2,554/100,000 to 1,659/100,000 for Rwanda, from 3,221/100,000 to 2,669/100,000 for WHO African Region, and increased from Page number not for citation purposes 7 490/100,000 to 500/100,000 for WHO Global, between 2001 and 2013 [22].The Rwanda HIV/AIDS prevalence is better than WHO African Region and worse than globally. Besides, the fastened achievement of 3% since 2005 versus the target set at 5% by 2020 is found as remarkable performance.
Indicator 21: prevalence of death rates associated with malaria: For Rwanda, the malaria morbidity and mortality reduced by 90% from 2000 to 2012. Between 2000 and 2015, the global malaria incidence rate has fallen by an estimated 37% and the mortality rate by 58% [22]. The malaria incidence accounted 5,673/100,000 for Rwanda, 18,526/100,000 for the WHO African Region i.e. three times higher than Rwanda, and 3,744/100,000 worldwide in 2013/2014 i.e. to-third lower than Rwanda [22]. Rwanda is less affected by the epidemic than WHO African Region and more affected than Global. The fastened attainment of the target set at malaria morbidity worth 5% by 2020 versus 50% between 1995-2003 is considered as remarkable performance.

Conclusion
The performance of Rwanda on the health-

Competing interests
The authors declare no competing interests.